Urinary incontinence (UI) is a physically, emotionally, and economically burdensome condition that is common among women of all ages. Yet, only a minority of women, even those with severe symptoms, discusses UI with their healthcare provider. The goal of this project is to provide data to inform decisions about UI care seeking and management, with the long-term aim of reducing UI burden. Our specific aims leverage detailed data on UI over up to 16 years among >140,000 women, aged 37-91 years, in the Nurses' Health Studies (NHS, NHSII). The first aim addresses the lack of data tracking UI natural history; improved knowledge of natural history will help facilitate discussions between women and clinicians about the expected course of UI symptoms and timing of prevention or management. We will track changes in UI frequency, severity, and subtype, collected via questionnaires administered every 2 to 4 years, over up to 16 years. Separate analyses will consider natural history within older and younger women. The second aim of this project is to evaluate potential determinants of care seeking for UI, which could help providers target and inform women who do not discuss their symptoms. We will specifically evaluate relations of UI characteristics (e.g., higher severity, more bother, mixed UI subtype, longer duration) and independent health factors (e.g., more co-morbidity, worse health- related quality of life) with self-reported discussions about UI with healthcare providers. In complement, we will also evaluate relations of potential determinants with UI identification by providers utilizing linked Medicare and NHS data. Finally, information on treatment likelihood, or on how different UI subtypes are treated, has not been possible to determine, since it requires joint knowledge of UI, UI characteristics, and treatments utilized. Thus, in the third aim we will leverage linked NHS and Medicare claims data to examine utilization of medical and surgical treatments for UI, including which patients receive (and don't receive) treatment, and how UI subtypes are treated. These data could help identify patients who might benefit from treatment discussions and help inform providers on treatment guidelines. Overall, the three aims of this proposal have direct clinical relevance to optimizing care for UI and reducing its burden.